Meta-analysis of factors associated with survival of neonatal hepatic abscess

Abstract

Neonatal hepatic abscess is a rare, but serious complication of umbilical line catheterization, conferring a high level of mortality. Given the infrequency of this condition, no evidenced-based data exists on treatment. To assess factors correlated with increased survival of published cases of neonatal hepatic abscess and discern implications for treatment. A systematic search of PubMed, MEDLINE, LEXIS-NEXIS Academic Universe, Biological Abstracts, BioMed Central and the Institute for Scientific Improvement’s Web of Knowledge and Web of Science bibliographies was performed to identify reports, case reviews and studies of neonatal hepatic abscess. Post-surgical incidences of hepatic abscess were excluded. A dataset of cases, which met inclusion criteria, was constructed including year of publication, cultured organisms in abscess, treatment (antibiotics or antibiotics plus surgical drainage), gestational age and outcome. Fisher’s exact test in bivariate analysis and multivariate logistic regression were performed to identify factors associated with survival. From 1967 to 2007, 41 cases of non-surgical neonatal hepatic abscess were identified with an overall mortality of 58.5%. A sharp decline in mortality (82.6% to 27.8%) after 1990 was noted. Use of vancomycin, single infectious organism and use of surgical drainage in conjunction with antibiotics were associated with survival in bivariate analysis. Using logistic regression, Gram-negative infection was associated with increased mortality and the use of vancomycin showed a trend toward improved survival. Neonatal hepatic abscess is a rare, highly lethal condition. Increased morbidity is seen in patients with Gram-negative infection. Based on the statistical review of published cases, use of vancomycin (regardless of organism) and use of surgical drainage in the treatment regimen may improve survival.

Keywords

Hepatic abscess - neonatal intensive care